ER1 – Patients’ individuality: challenges facing hospital pharmacists

Link to EAHP Statements

• Section 4 – Clinical Pharmacy Services: Statements – 4.1, 4.3
• Section 6 – Education and Research: Statements – 6.1, 6.2, 6.3

ACPE UAN: 0475-0000-23-019-L04-P – A knowledge-based activity

Abstract

Patients respond differently to medications due to many reasons, which can either be intrinsic (age, race, weight, metabolic capacity, genetics) or extrinsic (co-medications, co-morbidities, etc.). These variations may be of pharmacokinetic or pharmacodynamic nature, implying that one dose does not suit everyone. To stratify dosing regimens for each individual patient, addressing the variability is essential. Interindividual differences in drug’s pharmacokinetics are easily observed, well documented and dosing regimens adjustments are required for clinically relevant variations. They imply that patients receiving the same dose of drug have different drug concentrations and/or exposures.

Since drug concentrations at target site are important for the response, relationship between drug’s pharmacokinetic and pharmacodynamic profile guide appropriate dosing regimen. Deviations in drug behaviour are observed between patients and healthy volunteers, but also among target patient population (such as age, disease, or other covariate-defined groups). However, in individual patients we may observe multiple factors influencing drug behaviour, and optimising dosing regimen requires the knowledge of the magnitude of the composite (combination of all factors) variability in individual patients.

Advanced computational methodologies have been developed to study and address the variations in drugs response, as well as to optimise dosing regimen to the patients’ needs. Since, clinical pharmacy services of the hospital pharmacists are oriented towards therapeutic decision-making processes, upgrading the knowledge of advanced tools of the covariates-based dosing is important aspect of continuing pharmacists’ training.

Learning objectives

After the session, participants should be able to:

• Recognise the reasons patient’s response differently to the same drug dosing regimen
• Understand the principles and tools used for drug dosing individualisation

Educational need addressed

Achieving optimal drug response in each individual patient requires education and training of hospital pharmacists regarding the sources of variability.

Keywords: variability, individualisation, computational tools